See also

Pertussis/Whooping cough
Asthma
Foreign body

Key Points

1. The most common cause of cough is an upper respiratory tract infection, usually viral in nature
2. In a well child with a normal examination, investigations and treatment are rarely needed
3. Children with persistent cough (longer than 3 weeks) may require further assessment
   

Background

• Cough is a non-specific symptom
• Young children develop 6-12 respiratory tract infections per year, usually accompanied by cough. In most children, the cough is self-limiting (1-3 weeks)
• In general, if a child presents with a history of daily cough for greater than 3 weeks, further assessment is required
• A productive cough is abnormal in children and usually has an identifiable specific cause

The most common cause of cough in children of all ages is upper respiratory infection. Other common causes vary according to the age of the child. Some examples include:

*In the absence of wheeze or dyspnoea, asthma is unlikely to cause non-specific isolated cough

Assessment

Red flag features in Red

History:

• Onset (eg sudden onset without a viral prodrome or onset after choking episode may suggest foreign body inhalation)
• Associated with feeds
• Type (eg paroxysmal cough may suggest pertussis, chlamydia, or foreign body. Honking or a bizzare disruptive cough may suggest psychogenic cough. Barking cough suggests croup)
• Pattern (eg if absent during sleep, consider habit cough)
• Distinguish recurrent episodes from continuous cough
• Symptoms of sinusitis, chronic rhinitis, atopic conditions and asthma
• Exercise tolerance
• Poor growth
• Any other medical concerns (eg recurrent pneumonia, cardiac disease, immunodeficiency)
• Exposure to passive smoking
  

Examination:

• Fever
• Loss of muscle bulk and subcutaneous fat stores
• Abnormal cardiac examination
• Clubbing
• Respiratory signs – particularly wheeze, differential air entry or crepitations
  

Management

In a well child with a normal examination, investigations and treatment are rarely needed. Chest X-ray and other investigations should be performed as indicated by clinical suspicion 

Well child, normal examination

• Reassure
• Avoid exposure to irritants such as cigarette smoke (see also smoking parents)
• Cough medicines, decongestants, antihistamines, antibiotics do NOT have a role
• Arrange follow up with local doctor in 2-3 weeks
  

Unwell child or abnormal examination 

• Treat according to findings and results of investigations
  

Persistent cough (greater than 4 weeks duration) consider:

• Normal (well child, normal examination) – as above
• Pertussis
• Asthma
• Foreign body
• Sinusitis
• Suppurative lung disease (daily wet cough, recurrent pneumonia)

If history or examination not consistent with any of the above, consider Chest X-Ray, spirometry and / or other investigations as needed – follow up with a Paediatrician 

Consider consultation with local paediatric team when

Unwell child
Persistent cough

Consider transfer when

Children requiring care above the level of comfort of the local hospital

For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

Consider discharge when

Child is stable
Investigations and follow up arranged if needed

Parent information sheet

Cough

Last Updated September, 2019